Nebbioso Marcella, Gregorio Fabio De, Prencipe Laura, Pecorella Irene
Department of Ophthalmology, Centre of Ocular Electrophysiology, University of Rome "Sapienza," Rome, Italy.
Optom Vis Sci. 2011 Aug;88(8):E928-39. doi: 10.1097/OPX.0b013e31821c6ca4.
The purpose of this study was to compare psychophysical and electrophysiological testings in early optic nerve dysfunction in a group of clinically asymptomatic subjects with suspect ocular hypertension (OHT).
Forty eyes of 40 patients with suspect OHT and asymmetrical horizontal cup/disc ratio (0.2/0.4), 22 eyes of 22 patients with open-angle glaucoma (OAG), and 40 eyes of 40 healthy controls were evaluated by using frequency-doubling technology perimetry (FDT), contrast sensitivity (CS), pattern electroretinography (PERG), and pattern visual-evoked potentials (VEP). The VEP were elicited by checkerboard stimuli with large (VEP 120), medium (VEP 45), and small (VEP 15) checks; then the values of the amplitude (A) and latency (L) of P100 peaks were studied. Receiver operator characteristic (ROC) curves were calculated to determine the sensitivity, specificity, and optimal cutoff points of abnormal values. A logistic regression analysis was performed to determine which tests were providing the most useful information. In addition, Kruskal-Wallis test was performed to test the differences between the control group and the OHT group.
VEP P100 peak latency (VEP L15 and VEP L45) and amplitude (VEP A120), PERG N95 peak amplitude, CS at medium spatial frequencies (CS 4SF), and FDT pattern standard deviation (PSD) yielded the greatest sensitivity (85.0 to 60.0%) and specificity (80.0 to 60.0%) ratio, displaying the largest ROC curve areas; whereas PERG N95 peak latency ROC curve had the smallest areas. Kruskal-Wallis test showed that most diagnostic tests were able to differentiate the OHT group from the control group. Stepwise logistic regression analysis identified VEP L15 (p < 0.001), CS 4SF (p = 0.023), FDT PSD (p = 0.032), and VEP A120 (p = 0.072) as tests that could be useful to distinguish controls from OHT.
Our data confirm that psychophysical and electrophysiological tests are useful for early detection of patients at risk of developing OAG.
本研究旨在比较一组临床无症状但疑似高眼压症（OHT）患者早期视神经功能障碍的心理物理学和电生理学检测方法。
对40例疑似OHT且水平杯盘比不对称（0.2/0.4）患者的40只眼、22例开角型青光眼（OAG）患者的22只眼以及40例健康对照者的40只眼，采用倍频视野计（FDT）、对比敏感度（CS）、图形视网膜电图（PERG）和图形视觉诱发电位（VEP）进行评估。VEP由大（VEP 120）、中（VEP 45）、小（VEP 15）方格的棋盘格刺激诱发；然后研究P100波峰的振幅（A）和潜伏期（L）值。计算受试者工作特征（ROC）曲线以确定异常值的敏感性、特异性和最佳截断点。进行逻辑回归分析以确定哪些检测提供了最有用的信息。此外，进行Kruskal-Wallis检验以测试对照组和OHT组之间的差异。
VEP P100波峰潜伏期（VEP L15和VEP L45）和振幅（VEP A120）、PERG N95波峰振幅、中等空间频率的CS（CS 4SF）以及FDT模式标准差（PSD）具有最高的敏感性（85.0%至60.0%）和特异性（80.0%至60.0%），显示出最大的ROC曲线面积；而PERG N95波峰潜伏期ROC曲线面积最小。Kruskal-Wallis检验表明，大多数诊断测试能够区分OHT组和对照组。逐步逻辑回归分析确定VEP L15（p < 0.001）、CS 4SF（p = 0.023）、FDT PSD（p = 0.032）和VEP A120（p = 0.072）可作为区分对照组和OHT的有用检测方法。
我们的数据证实，心理物理学和电生理学检测方法有助于早期发现有患OAG风险的患者。
